Tag: statistics

J Am Med Dir Assoc. 2023 May 8:S1525-8610(23)00379-1. doi: 10.1016/j.jamda.2023.04.002. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate mental health needs and barriers to seeking mental health support in Medicaid-funded Assisted Living Facility (M-ALF).

DESIGN: A multimethod, qualitative-dominant descriptive design using questionnaires and semistructured interviews.

SETTING AND PARTICIPANTS: The study occurred at a M-ALF in the Bronx, New York. A researcher in residence recruited 13 residents (11 Black or African American, 2 Asian) using purposive sampling.

METHODS: Demographic data and mental health indicators (depression, anxiety, stress, hopelessness) were measured with questionnaires (Center for Epidemiological Studies Depression Scale, Edmonton Symptom Assessment System, Perceived Stress Scale, Beck Hopelessness Survey) and analyzed with descriptive statistics. Interviews were conducted between June and November 2021, transcribed, and analyzed using conventional content analysis.

RESULTS: Thirteen residents (mean age: 73.4 years, mean length of stay: 3.5 years; range: 1.0-7.5) completed data collection. Quantitatively indicators of unmet mental health were common. Qualitatively, residents reported barriers to mental health access to address depression, anxiety, and substance use. This was accompanied by concerns surrounding loss of autonomy, mistrust for M-ALF organizational support, isolation and uncertainty about how to receive mental health support. Perspectives were shaped by past experiences with institutional living, serious illness, and being unhoused. Themes and subthemes were (1) mental health need (unmet mental health need, depression, and anxiety and seeking support through non-mental health resources) and (2) barriers to mental health support (dissatisfaction with M-ALF care, perceived threats to autonomy, desire for autonomy that leads to diminished care seeking).

CONCLUSION AND IMPLICATIONS: Residents of M-ALF have mental health needs for which care is stymied by loss of autonomy, lack of resources, and the M-ALF environment. Residents use unconventional resources to address needs that may be neither efficient nor effective. Novel mental health interventions and processes are needed to improve mental health access and should prioritize residents’ desire for autonomy and the unique circumstances of living in M-ALF.

PMID:37169346 | DOI:10.1016/j.jamda.2023.04.002

J Pediatr (Rio J). 2023 May 8:S0021-7557(23)00051-7. doi: 10.1016/j.jped.2023.03.007. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine reference intervals (RI) for serum immunoglobulin A (IgA) levels in healthy children aged 1 to 11 years residing in the central region of Brazil.

METHODS: This cross-sectional study was conducted on 1,743 healthy children randomly selected from kindergartens and public schools in Cuiabá, MT, Brazil. The IgA RIs were defined using the statistical methods postulated by the guidelines of the United States Clinical and Laboratory Standards Institute, the nonparametric bootstrap method, and Horn’s robust method after the correction of discrepancies by Tukey’s, Dixon’s, and Horn’s methods, respectively. The results were defined based on the values contained between the 2.5th and 97.5th percentiles and their respective 95% confidence intervals.

RESULTS: Partition by sex was not necessary to determine the IgA RI of the studied children. Homogeneous subgroups were identified among children aged 1-<2, 2-<5, and 5-<11 years, whose IgA-specific RIs were determined.

CONCLUSION: The serum IgA RIs were established for three groups of Brazilian children aged 1-11 years, which differed from those currently applied in Brazilian pediatric practice and from those defined by international studies. This definition will help Brazilian pediatricians formulate an accurate diagnosis and facilitate decision-making.

PMID:37169344 | DOI:10.1016/j.jped.2023.03.007

Microb Pathog. 2023 May 9:106149. doi: 10.1016/j.micpath.2023.106149. Online ahead of print.

ABSTRACT

The abundance of specific gut microorganisms is strongly associated with the concentrations of microbially modified bile acids. This study aimed to investigate the composition of intestinal microbiota in rats subjected to bile duct ligation or biliary drainage. Extrahepatic bile duct ligation was conducted to induce bile duct obstruction in rats. The bile was drained via a percutaneous biliary drainage catheter to cause bile deficiency. The total DNA extracted from fecal samples was sequenced with 16S DNA sequencing. Taxonomic classifications were conducted using the Mothur algorithm and SILVA138 database and were presented along with the abundance presented using a heatmap. The inter- and intra-group differences in the intestinal microbiome composition were analyzed by ANOSIM test. The biomarker microorganisms were screened using the Linear discriminant analysis Effect size method. The possible functional pathways were predicted using the Tax4Fun package. A total of 3277 operational taxonomic units (OTUs) were examined, with 2410 in the Kongbai group, 2236 in the Gengzu group, and 1763 in the Yinliu group. The composition of microorganisms at the levels of phylum, class, order, family, and genus was altered in rats with bile duct obstruction. This composition was then restored by biliary drainage. The top 10 predominant microorganisms were identified that led to the inter-group differences. Functional annotation revealed that the potential functions of the microorganisms with significant differences were enriched in metabolism, cellular processes, and genetic and environmental information processing. The intestinal microbial community was significantly changed in rats with bile duct obstruction. The changes in the abundance of intestinal microbiota Prevotellaceae and Enterobacteriaceae were statistically significant after biliary drainage treatment.

PMID:37169314 | DOI:10.1016/j.micpath.2023.106149

Prev Med. 2023 May 9:107536. doi: 10.1016/j.ypmed.2023.107536. Online ahead of print.

ABSTRACT

Few studies have examined associations between the retail food environment and weight maintenance. This study examined the residential Retail Food Environment Index (RFEI) of weight loss maintainers and associations with weight maintenance duration, perceived effort and difficulty managing weight, and coping and monitoring strategies. Participants were 6947 members of the WW Success Registry (enrolled January 2018-February 2020), a nationwide (United States) convenience sample of individuals who lost weight using Weight Watchers (WW) and maintained a ≥ 9.1 kg weight loss for ≥1 year (Mean 24.7 kg loss for 3.4 years). Home addresses were geo-coded and the RFEI (ratio of unhealthy [fast-food and convenience stores] to healthy [supermarkets, grocery stores, and fruit/vegetable vendors] outlets) was used to classify the healthfulness of the food environments. Validated questionnaires measured psychological coping and self-monitoring. Compared to individuals living in the healthiest food environments (RFEI<1.6), those in the least healthy food environments (RFEI ≥4.0) maintained weight loss for 0.5 years less (3.2 vs 3.7 years; 95% CI between-group difference = 0.20, 0.80), reported statistically higher scores but not clinically relevant differences on perceived effort (4.6 vs. 4.5; 95% between-group difference = 0.01, 0.21) and difficulty managing their weight (3.1 vs. 3.0; 95% CI between-group difference = 0.01, 0.17) and practice of self-monitoring (2.7 vs. 2.6; 95% CI between-group difference = 0.01, 0.14). No differences in psychological coping were observed. Weight loss maintainers living in the least healthy retail food environments maintained weight loss for a shorter duration compared to those in the healthiest food environments.

PMID:37169304 | DOI:10.1016/j.ypmed.2023.107536

Radiother Oncol. 2023 May 9:109700. doi: 10.1016/j.radonc.2023.109700. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to evaluate the effectiveness and safety of high-dose (HD-RT) versus standard-dose radiotherapy (SD-RT) in concurrent chemoradiotherapy (CCRT) for inoperable esophageal cancer (EC) patients.

METHODS: A systematic search of the literature was conducted by screening PubMed, Web of Science, EMBASE and Cochrane Library databases before October 7, 2022 to collect controlled clinical studies of high-dose (≥ 60Gy) and standard-dose (50-50.4Gy) radiation in CCRT for EC. For statistical analysis, a fixed-effects model was used to synthesize HR and OR if there was no significant heterogeneity among studies; otherwise, a random-effects model was employed.

RESULTS: There were ten studies with 4625 patients included in the study, 3667 of whom (79.3%) were esophageal squamous cell carcinoma (ESCC). The HD-RT group had no significant benefits in overall survival (OS) (HR = 0.88, 95% confidence interval [CI] = 0.74-1.05, P = 0.16) and progression-free survival (HR = 0.84, 95%CI = 0.67-1.04, P = 0.12) in total EC patients, compared with SD-RT group. However, in ESCC subgroup analysis, compared with SD-RT group, a better OS was observed in the HD-RT group (HR = 0.78, 95%CI = 0.70-0.88, P < 0.0001).

CONCLUSION: Compared with the radiation dose of 50-50.4Gy, the increase of radiation dose (≥ 60Gy) did not achieve benefits in survival for inoperable EC patients receiving CCRT. However, in patients with ESCC, high dose (≥ 60Gy) of radiation probably improved OS.

PMID:37169302 | DOI:10.1016/j.radonc.2023.109700

Am J Obstet Gynecol MFM. 2023 May 9:101012. doi: 10.1016/j.ajogmf.2023.101012. Online ahead of print.

ABSTRACT

BACKGROUND: Some data suggest an association between abnormal fetal fraction on noninvasive prenatal screen and adverse pregnancy outcomes including low birthweight, preeclampsia, and preterm birth in the absence of aneuploidy. These findings suggest that abnormal fetal fraction may be associated with placental pathologic processes in early gestation.

OBJECTIVE: The purpose of this study is to determine the independent association of fetal fraction on genetic noninvasive prenatal screen and histologic placental types.

STUDY DESIGN: This is a retrospective cohort study at a single institution between January 2017 and March 2021 of livebirths ≥ 24 weeks who had noninvasive prenatal screen (NIPS) and placental pathology results available. Results were stratified by trimester of NIPS. Clinical characteristics were compared by quartile of FF using chi square tests. Linear regression was used to model continuous FF as a function of 3 histologic types representing chronic placental injury- chronic inflammation, maternal vascular malperfusion (MVM), and fetal vascular malperfusion. Inverse probability weighting was used to account for selection bias in characteristics of patients with placental pathology examination.

RESULTS: 1,374 patients had NIPS in the first trimester and 262 in the second trimester. Preterm birth and hypertensive disorders of pregnancy were most common in the lowest quartile of FF. Chronic inflammation was associated with a 0.56 percentage point reduction in FF (95% CI: -0.95, -0.16) and MVM was associated with 0.48 percentage point reduction in FF (95% CI: -0.91, -0.04) in adjusted models. The association with MVM was no longer statistically significant after accounting for selection bias in placentas sent for pathologic examination. Second trimester FF was not associated with placental pathology.

CONCLUSION: Chronic inflammation is associated with lower first trimester FF even after accounting for selection bias. Higher fetal fraction in the second trimester was associated with fetal vascular pathology, although this association was no longer statistically significant after inverse probability weighting to account for selection bias. First trimester FF may be a biomarker of adverse outcomes associated with chronic inflammation.

PMID:37169285 | DOI:10.1016/j.ajogmf.2023.101012

Nucleic Acids Res. 2023 May 11:gkad325. doi: 10.1093/nar/gkad325. Online ahead of print.

ABSTRACT

The mpox virus (MPXV) is mutating at an exceptional rate for a DNA virus and its global spread is concerning, making genomic surveillance a necessity. With MpoxRadar, we provide an interactive dashboard to track virus variants on mutation level worldwide. MpoxRadar allows users to select among different genomes as reference for comparison. The occurrence of mutation profiles based on the selected reference is indicated on an interactive world map that shows the respective geographic sampling site in customizable time ranges to easily follow the frequency or trend of defined mutations. Furthermore, the user can filter for specific mutations, genes, countries, genome types, and sequencing protocols and download the filtered data directly from MpoxRadar. On the server, we automatically download all MPXV genomes and metadata from the National Center for Biotechnology Information (NCBI) on a daily basis, align them to the different reference genomes, generate mutation profiles, which are stored and linked to the available metainformation in a database. This makes MpoxRadar a practical tool for the genomic survaillance of MPXV, supporting users with limited computational resources. MpoxRadar is open-source and freely accessible at https://MpoxRadar.net.

PMID:37167010 | DOI:10.1093/nar/gkad325

Stat Methods Med Res. 2023 May 11:9622802231167435. doi: 10.1177/09622802231167435. Online ahead of print.

ABSTRACT

Dynamic treatment regimens (DTRs), also known as treatment algorithms or adaptive interventions, play an increasingly important role in many health domains. DTRs are motivated to address the unique and changing needs of individuals by delivering the type of treatment needed, when needed, while minimizing unnecessary treatment. Practically, a DTR is a sequence of decision rules that specify, for each of several points in time, how available information about the individual’s status and progress should be used in practice to decide which treatment (e.g. type or intensity) to deliver. The sequential multiple assignment randomized trial (SMART) is an experimental design widely used to empirically inform the development of DTRs. Sample size planning resources for SMARTs have been developed for continuous, binary, and survival outcomes. However, an important gap exists in sample size estimation methodology for SMARTs with longitudinal count outcomes. Furthermore, in many health domains, count data are overdispersed-having variance greater than their mean. We propose a Monte Carlo-based approach to sample size estimation applicable to many types of longitudinal outcomes and provide a case study with longitudinal overdispersed count outcomes. A SMART for engaging alcohol and cocaine-dependent patients in treatment is used as motivation.

PMID:37167008 | DOI:10.1177/09622802231167435

JMIR Form Res. 2023 May 11;7:e44831. doi: 10.2196/44831.

ABSTRACT

BACKGROUND: Misleading health claims are widespread in the media, and making choices based on such claims can negatively affect health. Thus, developing effective learning resources to enable people to think critically about health claims is of great value. Serious games can become an effective learning resource in this respect, as they can affect motivation and learning.

OBJECTIVE: This study aims to document how user insights and input can inform the concept and development of a serious game application in critical thinking about health claims in addition to gathering user experiences with the game application.

METHODS: This was a mixed methods study in 4 successive phases with both qualitative and quantitative data collected in the period from 2020-2022. Qualitative data on design and development were obtained from 4 unrecorded discussions, and qualitative evaluation data were obtained from 1 recorded focus group interview and 3 open-ended questions in the game application. The quantitative data originate from user statistics. The qualitative data were analyzed thematically, and user data were analyzed using nonparametric tests.

RESULTS: The first unrecorded discussion revealed that the students’ (3 participants’) assessment of whether a claim was reliable or not was limited to performing Google searches when faced with an ad for a health intervention. On the basis of the acquired knowledge of the target group, the game’s prerequisites, and the technical possibilities, a pilot of the game was created and reviewed question by question in 3 unrecorded discussions (6 participants). After adjustments, the game was advertised at the Oslo Metropolitan University, and 193 students tested the game. A correlation (r=0.77; P<.001) was found between the number of replays and total points achieved in the game. There was no demonstrable difference (P=.07) between the total scores of students from different faculties. Overall, 36.3% (70/193) of the students answered the evaluation questions in the game. They used words such as “fun” and “educational” about the experiences with the game, and words such as “motivating” and “engaging” related to the learning experience. The design was described as “varied” and “user-friendly.” Suggested improvements include adding references, more games and modules, more difficult questions, and an introductory text explaining the game. The results from the focus group interview (4 participants) corresponded to a large extent with the results of the open-ended questions in the game.

CONCLUSIONS: We found that user insights and inputs can be successfully used in the concept and development of a serious game that aims to engage students to think critically about health claims. The mixed methods evaluation revealed that the users experienced the game as educational and fun. Future research may focus on assessing the effect of the serious game on learning outcomes and health choices in randomized trials.

PMID:37166972 | DOI:10.2196/44831

JMIR Diabetes. 2023 May 11;8:e44295. doi: 10.2196/44295.

ABSTRACT

BACKGROUND: A very low-carbohydrate (VLC) nutritional strategy may improve glycemic control and weight loss in adults with type 2 diabetes (T2D). However, the supplementary behavioral strategies that might be able to improve outcomes using this nutritional strategy are uncertain.

OBJECTIVE: This study aims to compare the impact of adding 3 different supplementary behavioral strategies to a web-based VLC diet intervention. To our knowledge, this is the first trial to randomize participants to different frequencies of dietary self-monitoring.

METHODS: The study included 112 overweight adults with T2D (hemoglobin A_1c ≥6.5%) taking no antiglycemic medications or only metformin. They received a remotely delivered 12-month VLC diet intervention. Participants were randomly assigned through a full factorial 2×2×2 design to supplementary strategies: either daily or monthly dietary self-monitoring, either mindful eating training or not, and either positive affect skills training or not. Our research goal was to determine whether 3 different supplemental strategies had at least a medium effect size (Cohen d=0.5).

RESULTS: Overall, the VLC intervention led to statistically significant improvements in glycemic control (-0.70%, 95% CI -1.04% to -0.35%; P<.001), weight loss (-6.82%, 95% CI -8.57% to -5.08%; P<.001), and depressive symptom severity (Cohen d -0.67, 95% CI -0.92 to -0.41; P<.001). Furthermore, 30% (25/83) of the participants taking metformin at baseline reduced or discontinued their metformin. Only 1 Cohen d point estimate reached 0.5; daily (vs monthly) dietary self-monitoring had a worse impact on depressive symptoms severity (Cohen d=0.47, 95% CI -0.02 to 0.95; P=.06). None of the strategies had a statistically significant effect on outcomes. For changes in our primary outcome, hemoglobin A_1c, the daily (vs monthly) dietary self-monitoring impact was 0.42% (95% CI -0.28% to 1.12%); for mindful eating, it was -0.47% (95% CI -1.15% to 0.22%); and for positive affect, it was 0.12% (95% CI -0.57% to 0.82%). Other results for daily (vs monthly) dietary self-monitoring were mixed, suggesting an increase in weight (0.98%) and depressive symptoms (Cohen d=0.47), less intervention satisfaction (Cohen d=-0.20), more sessions viewed (3.02), and greater dietary adherence (Cohen d=0.24). For mindful eating, the results suggested a benefit for dietary adherence (Cohen d=0.24) and intervention satisfaction (Cohen d=0.30). For positive affect, the results suggested a benefit for depressive symptoms (Cohen d=-0.32), the number of sessions viewed (3.68), dietary adherence (Cohen d=0.16), and intervention satisfaction (Cohen d=0.25).

CONCLUSIONS: Overall, our results support the use of a VLC diet intervention in adults with T2D. The addition of monthly (not daily) dietary self-monitoring, mindful eating, and positive affect skills training did not show a definitive benefit, but it is worth further testing.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03037528; https://clinicaltrials.gov/ct2/show/NCT03037528.

PMID:37166961 | DOI:10.2196/44295